tbuckley/cabot-search huggingface dataset:
Abstract P151: Late-Life Prediabetes, Diabetes, and Diabetes Duration With Risks of Frailty and Mortality: The Atherosclerosis Risk in Communities (ARIC) Study
Authors: Mary R Rooney, B Gwen Windham, Priya Palta, Justin B Echouffo Tcheugui, Laura Skow, Elizabeth Selvin
Journal: Circulation (2023)

Introduction: Diabetes is a risk factor for frailty and mortality. Longer diabetes duration is associated with higher mortality in older adults, whereas prediabetes is not. Little has been characterized on associations of prediabetes and diabetes duration with frailty risk. Characterizing frailty and mortality risk in older adults with prediabetes and diabetes is useful for planning healthcare resource utilization. Hypothesis: Longer diabetes duration, but not prediabetes, is associated with higher risks of frailty and mortality in older adults. Methods: We conducted a prospective analysis of 4119 ARIC Study participants (mean age 75, 56% women, 22% Black adults) who attended visit 5 (2011-3) without prevalent frailty and who attended visit 6 (2016-7) or died without attending visit 6. We used the Fried phenotype to classify frailty based on ≥3 components: unintentional weight loss, exhaustion, grip strength, slow walking speed, low physical activity. We used multinomial logistic regression to estimate relative risk ratios (RRR) for baseline categories of normoglycemia (HbA1c&lt;5.7%), prediabetes (HbA1c 5.7-&lt;6.5%), or diabetes duration &lt;5, 5-&lt;10, or ≥10 years with incident frailty and death. Results: Over 5 years of follow-up, there were 851 deaths and 229 frailty cases detected at visit 6. The 5-year cumulative incidence of frailty was 3% in older adults without diabetes and 5% in those with diabetes, and the 5-year mortality risk was 15% in older adults without diabetes and 25% in those with diabetes. Compared to those with normoglycemia, older adults with diabetes ≥10 years had higher risk of frailty or mortality after multivariable adjustment ( Table ). Older adults with prediabetes did not have higher risk of frailty or death. Conclusion: In older adults, longer diabetes duration was associated with high risks of frailty and mortality, whereas prediabetes was not associated with frailty and mortality. Older adults with long-standing diabetes should be targeted for frailty screening and preventive interventions.
Abstract 47: Mid-Life Vascular Risk and Rate of Physical Function Decline Among Older Adults: The Atherosclerosis Risk in Communities Study
Authors: Laura Skow, Jennifer Schrack, Josef Coresh, Jennifer A Deal, Rebecca F Gottesman, A R Sharrett, Priya Palta, Michael Griswold, Kevin Sullivan, B Gwen Windham
Journal: Circulation (2023)

Introduction: Physical function decline is associated with poor outcomes, including disability and death. Late-life vascular risk burden is associated with faster physical decline, but earlier life course influence is still unknown. We hypothesized that higher mid-life vascular risk is associated with faster late-life physical function decline. Methods: We studied 5,481 adults at visit 5 (mean [SD] age=75.8 [5.0], range=67-91 years, 58% women, 21% Black) without stroke or Parkinson disease. Mid-life hypertension (≥140/90 mm Hg or treatment), diabetes (≥126 mg/dL or treatment), high cholesterol (≥240 mg/dL or treatment), and current smoking were assessed at visit 1 (age=45-64 years) and across visits 1-4. Late-life physical function in the Short Physical Performance Battery (SPPB) was assessed at visits 5-7 (median follow-up: 4.8 years). Random-slope, random-intercept linear mixed models tested interactions between rate of SPPB decline and mid-life risk factors, adjusted for visit 5 age, sex, race-site, education, BMI, coronary heart disease, and heart failure. Results: Mid-life hypertension (+57% decline: 0.47 per 5 years, 95% CI: 0.30-0.64, p&lt;0.001) and diabetes (+73% decline: 0.67 per 5 years, 95% CI: 0.24-1.09, p=0.002) were associated with faster SPPB decline compared to midlife low risk (Figure 1), as were higher systolic blood pressure (+17% per SD: 0.16 per 5 years, 95% CI: 0.10-0.23, p&lt;0.001) and fasting blood glucose (+16% per SD: 0.015 per 5 years, 95% CI: 0.06-0.24, p=0.002). Greater cumulative years of exposure to hypertension and diabetes were associated with faster rates of SPPB decline (+32% decline: 0.93 per 5 years, 95% CI: 0.61-1.25, p&lt;0.001) and diabetes (+35% decline: 1.03 per 5 years, 95% CI: 0.38-1.68, p=0.002). Conclusions: Older adults with mid-life hypertension and diabetes had faster rates of late-life physical function decline. Midlife control of blood pressure and diabetes may ameliorate late-life functional decline.
Abstract P618: Visceral and Subcutaneous Adipokine Expression and Serum Adipokine Levels Are Differentially Associated With Metabolic Risk
Authors: Bige Ozkan, Amelia S Wallace, Carine Hamo, Risa Wolf, Justin B Echouffo Tcheugui, Alexander Arking, Gary Gerstenblith, Xin Chu, G. Craig Wood, Peter Benotti, G William Wong, Josef Coresh, Chiadi E Ndumele
Journal: Circulation (2023)

Background: Adipokines mediate many metabolic effects of adipose tissue. While regional body composition is associated with metabolic risk, it is unclear if metabolic risk associations differ for adipokine expression in visceral and subcutaneous tissue and adipokine concentrations in the circulation. Methods: We obtained visceral and subcutaneous fat samples, and pre-surgical serum samples from Geisinger Obesity Registry patients undergoing bariatric surgery. We used real-time PCR to quantify mRNA expression of adipokines (adiponectin, leptin, leptin/adiponectin ratio) in fat samples, and targeted assays (ELISA) to measure serum adipokines. Using multivariable linear regression, we evaluated the individual and combined associations of visceral, subcutaneous and serum adipokines (per-1-SD and tertiles) with a metabolic syndrome (MetS) severity Z-score. Results: 181 participants (mean age 45 years, mean BMI 47 kg/m 2 , 85% female) with available fat and serum samples were included. Visceral, subcutaneous and serum adipokines were all weakly correlated (all ρ&lt;0.15). Each 1-SD higher visceral adipokine expression and serum adipokine concentrations were significantly associated with MetS z-score, whereas no associations with MetS z-score were seen for subcutaneous adipokine expression (Table). Individuals in the top tertile of leptin/adiponectin ratio in serum only (ß=0.29, 95%CI: 0.01, 0.57) or in visceral fat only (ß=0.37, 95%CI: 0.08, 0.66) had higher metabolic risk than those in the top tertile in neither visceral fat nor serum (Figure). However, those in the top leptin/adiponectin tertile in both in visceral fat and serum had the greatest metabolic risk (ß=0.78, 95%CI: 0.46, 1.11). Conclusion: Visceral, but not subcutaneous, adipokine expression provides complementary information to serum adipokines on metabolic risk. This indicates significant differences in the physiologic impact of regional adipose tissue and highlights adipokines as a potential target for modifying cardiometabolic risk.
Abstract P578: A Survey Study: Educational Session on South Asian and Cardiovascular Disease
Authors: Priya A Uppal, Drishti Patel, Aneri Patel, Divya Mohanraj, Shivali Gupta, Deepika Kothakapa, Mano Senthil, Devneet Singh, Rushali Kothari, Ashna Gupta, Sai Sahitha Somepalle, Avi Sura, Taniya T Thomas, Tiffany Vembenil, Soumya Neravetla, Surender Neravetla, Ashwat S Dhillon
Journal: Circulation (2023)

Introduction: South Asians have an earlier onset of and higher mortality from cardiovascular and ischemic heart disease compared to other ethnic groups in the US. There is a deficit in research regarding the genetic and environmental causes of cardiovascular health outcomes in South Asian communities in the US. Community health literacy on this issue can encourage lifestyle changes that reduce the likelihood of cardiovascular disease. Methods: An hour-long virtual presentation was conducted detailing cardiovascular health risk factors and recommendations to South Asians. The presentation was disseminated to participants over the age of 18 nationally. A pre-survey and post-survey assessing knowledge and attitude change from the presentation were administered. Descriptive statistics were used to analyze the data. Results: Conclusions: Our respondents had significant knowledge about cardiovascular health and were quite healthy overall. We recommend increased educational awareness of heart disease amongst South Asians in the broader community by providing tailored diet and exercise recommendations.
Abstract P219: An Elevated Consumption of Ultra-Processed Food Modifies the Association of Body Mass Index With All-Cause Mortality: Prospective Analyses From the Moli-Sani Study
Authors: Marialaura Bonaccio, Augusto F Di Castelnuovo, Emilia Ruggiero, Simona Costanzo, Simona Esposito, Anwal Ghulam, Chiara Cerletti, Maria Benedetta Donati, Giovanni de Gaetano, Licia Iacoviello
Journal: Circulation (2023)

Introduction: Body mass index (BMI) has J-shaped associations with all-cause mortality, but it is unclear whether diet can modify the impact of BMI on mortality. Hypothesis: We tested the hypothesis that a large dietary share of ultra-processed food (UPF) can act as an effect modifier of this association. Methods: Longitudinal analysis on 22,836 women and men (mean age 55±12 y) from the Moli-sani Study (2005-2010) with BMI values ≥18.5 kg/m 2 . Food intake was assessed by a 188-item FFQ. UPF was defined by the NOVA classification, and calculated as the proportion (%) of UPF in the total weight of food eaten (g/d). The Food Standards Agency nutrient profiling system (FSAm-NPS) dietary index was used to evaluate participants’ diet quality. To test for a non-linear, continuous relationship of BMI with mortality, we used multivariable Cox regression analysis with BMI modelled as restricted cubic splines and used the value of 25 kg/m 2 as the reference value. Main analyses were stratified by baseline low or high UPF consumption (i.e. below or above our population sex-specific median of UPF consumption, respectively). Results: Over a median follow-up of 12.2 y, 2,230 all-cause deaths occurred. In multivariable-adjusted models also including the FSAm-NPS dietary index and UPF, BMI had a J-shaped association with mortality (p-value&lt;0.001; p for non-linearity&lt;0.001); amongst lower UPF consumers, BMI values ≥33.6 kg/m 2 were associated with increased death risk, while BMI values ≤25 kg/m 2 were not ( Figure ). Higher UPF consumers experienced greater mortality risk both at higher and lower BMI values ( Figure ; p for interaction across UPF intake groups=0.016). Conclusions: In this cohort of adult Italians, UPF consumption acts as an effect modifier of the association between BMI and mortality, regardless of the overall diet quality. These findings suggest that a body weight considered to be healthy, when associated with a large dietary share of highly processed foods, is unlikely to provide substantial long-term health advantages.
Abstract 02: Intergenerational Socioeconomic Mobility is Associated With Adulthood All-Cause Mortality in the Hispanic Community Health Study/Study of Latinos
Authors: Adam M Whalen, Paola Filigrana, Krista M Perreira, Linda C Gallo, Robert Kaplan, Shakira F Suglia, Jianwen Cai, Maria M Llabre, Christina Cordero, Frank J Penedo, David J Lee, Martha L Daviglus, Amber Pirzada, Margaret Pichardo, Carmen R Isasi
Journal: Circulation (2023)

Introduction: Different patterns of socioeconomic mobility (SEM) across the life course may influence the risk of all-cause mortality in adulthood. Lifetime low socioeconomic status and downward social mobility may be associated with a higher risk of mortality. Hypothesis: SEM is associated with mortality, and persons with enduring intergenerational adversity or downward SEM have a higher risk of mortality compared to persons with enduring intergenerational advantage. Methods: This study included 13,459 participants, 18-74 years of age, from the Hispanic Community Health Study/Study of Latinos who participated in the baseline visit (2008-2011) and were not missing key covariate information. Socioeconomic position (SEP) was assessed as parental education in childhood (dichotomized at high school), and a 5-facet index of SEP in adulthood across education, income, employment status, longest held occupation type, and homeownership. The adulthood SEP index was dichotomized at the median value of 2 (range: 0-5). Childhood and adulthood SEP were then combined into a single 4-level measure of SEM (enduring advantage, upward mobility, downward mobility, and enduring adversity). Multivariable sampling weight-adjusted Cox proportional hazards regression was performed to estimate the association between SEM and all-cause mortality. Potential confounders included age, gender, Hispanic/Latino ethnic background, US nativity, years spent in the US, and study center, whereas alcohol and tobacco use, depression score, and BMI were considered potential mediators. Presence of mediation was assessed by calculating total and direct effects via modeling, then evaluating percent change from total to direct effects against a 10% guideline. Results: During the follow-up period of 2008-2019, 515 deaths were recorded. After adjusting for all potential confounders, a significant association was found between adulthood all-cause mortality and SEM overall (F = 7.62, p &lt; 0.0001). Downward mobility had significantly higher hazard of death compared to enduring advantage (aHR: 1.81, 95% CI: 1.17-2.81), although upward mobility and enduring adversity groups were not significant. The direct effect for downward mobility was reduced after adjustment for potential mediators (aHR: 1.49, 95% CI: 0.96, 2.30). Conclusions: Socioeconomic mobility, specifically downward mobility, is associated with all-cause mortality among a diverse cohort of Hispanic/Latino individuals residing in the United States. This association shows evidence of mediation by clinical and behavioral characteristics.
Abstract P271: Spatiotemporal Trends of Cardiovascular Incidence in U.S. Veterans From 2003-2018
Authors: Tamar S Polonsky, Daniel C Posner, Yuk-Lam Ho, Monica C Serra, Serena C Houghton, Kerry L Ivey, Yanping Li, David R Gagnon, Luc Djousse, Kelly M Cho, Peter W Wilson
Journal: Circulation (2023)

Introduction: Cardiovascular disease (CVD) is the leading cause of mortality and disability in the United States. Spatiotemporal modeling of disease incidence may guide prevention efforts toward regions most at risk in the future. Methods: We examined spatiotemporal trends in composite CVD events, defined as myocardial infarction, ischemic stroke, atrial fibrillation, heart failure, coronary artery disease, or cardiovascular death, using electronic health records from 9,718,107 U.S. Veterans who used VA healthcare facilities from 2003-2018. Age-standardized annual incidence by state was modeled using the Bernardinelli model, a Bayesian Poisson regression with linear temporal trends for the US and individual states. Results: There were 626,271 CVD events over 16 years of follow up and annual incidence fell gradually from 11.5% in 2003 to 6.6% in 2018. Incidence among all US veterans decreased an estimated 3.1% [95% CI: -3.3%, -2.9%] per year (RR year = 0.969). State-level incidences also decreased monotonically over the follow-up period (Figure panel A ), ranging from an absolute decrease 5.0% (RI) to 1.7% (OR). Estimated incidence for the five states most above (RI, FL, NC, MT, LA) and most below (OR, NV, CT, OK, MI) the national trend are plotted against the US average in Figure panel B . These outlying states differed significantly from the overall trend (posterior probabilities ≥ 99.7%), and the magnitude of trend was loosely correlated with initial incidence rate (in 2003). Notably, four states crossed the national average over the study period: CT and OK started below average in 2003 but ended above in 2018, whereas RI and NC started with high incidence and ended with below average incidence in 2018. Conclusions: Among US veterans, there was significant geographic variation in the rate of decline of incident CVD from 2003-2018. Future research will investigate the mechanisms underpinning the observed trends, particularly prevalence and control of risk factors.
Abstract P441: Association of Monthly Resistance Training Volume With All-Cause Mortality in NHANES 1999-2006
Authors: Robert Booker, Shaina Alexandria, Mandy Wong, Mercedes R Carnethon
Journal: Circulation (2023)

Introduction: The WHO Physical Activity Guidelines recommend at least 2 days of resistance training (RT) per week. RCTs have shown a dose-response between RT volume and improving blood pressure, lipids, and markers of glycemia. There is discordance between the Guidelines recommending a frequency while empirical evidence supports a volume. Our objective was to test whether RT Guidelines and volume were associated with lower mortality. Methods: Data are from the 1999–2006 NHANES cycles. Participants self-reported past 30 days of physical activity including type, which was used to assign METs, number of sessions, and average session duration in minutes. Those who reported engaging in RT (push-ups, sit-ups, and weightlifting) with no missing data were included ( N =1,391). RT volume was measured in monthly MET-minutes, calculated as the product of the number of sessions, mean session duration, and intensity. Mortality was ascertained from the linked National Death Index through the end of 2019. Covariates included monthly aerobic physical activity volume, sex, age, and education. Cox proportional hazards regression was used to estimate hazard ratios for all-cause mortality by RT Guideline adherence and RT volume. Results: Participants had a mean age of 41.3±16.3 years and were mostly male (62.7%). Most participants met the Guidelines ( n =1,041, 74.8%). The mean monthly RT volume was 2,210±2,550 MET-minutes. Mortality incidence was 11.4% with a mean follow-up time of 189±41.6 months (159 events, 263,585 total person-months). Neither meeting the Guidelines nor monthly RT volume was associated with all-cause mortality (Table 1.). There was no evidence of effect modification by sex or age. Conclusions: According to these findings, current Guidelines promoting RT for health benefits are not supported by empirical data. However, the absence of an association between monthly RT volume and all-cause mortality warrants further investigation using better instrumentation for assessing RT volume.
Abstract P577: Demographic Disparities in the Distribution and Severity of Coronary Artery Disease- An Urban-Suburban Comparative Study
Authors: Adeyinka Adeniyi, Kelechi O Weze, Paul L Douglass
Journal: Circulation (2023)

Background: Some small powered studies have suggested a paradoxical finding of less severe coronary artery obstruction in African American (AA) males as compared to Caucasian male patients despite a higher prevalence of CVD mortality in AAs. We performed a retrospective study to further identify the difference in the extent of coronary artery obstruction and the prevalence of multivessel disease between an urban hospital and a suburban hospital. Methods: A chart review of cardiac catheterization reports was performed on 3,579 patients from 2 different hospitals (1 urban and 1 suburban center). Statistical analysis was done using R and Stata. Results: Analyzing the main characteristics of the patient population we found that the suburban patient population (SPP) was 7 years older than the urban patient population (UPP) (P-valve= &lt;0.001), 78.4% of the suburban population were Caucasian while 79.7% of the urban center patient population were African Americans (P value= &lt;0.001). 96% of the patient population at the suburban center were insured while 85% of patients at the urban center were insured (P= &lt;0.001). Comorbidity burden was overall higher in the SPP ( P-Value= &lt; 0.001). SPPs were found to have a higher prevalence of severe CAD than UPP (Table 1). However, no significant difference was noted when comparing the prevalence of multivessel disease (Table 2). Conclusion: SPPs are more likely to have severe CAD than UPPs but with a similar level of CAD distribution.
Abstract MP40: John Henryism Moderates the Association Between Income and Heart Failure Among African American Adults From the Jackson Heart Study
Authors: LaShaunta M Glover, Allana Forde, Reed DeAngelis, Md Abu Yusuf Ansari, Mario Sims, Sherman James
Journal: Circulation (2023)

Background: The John Henryism Hypothesis (JHH) posits that repeated high-effort coping in response to systemic social and economic stressors accelerates physiological wear and tear and is, as a result, a major contributor to the well-documented high cardiovascular disease (CVD) risk among African American adults, especially the poor and working-class. There is, however, a paucity of studies that test the JHH using multiple socioeconomic status (SES) indicators and include incident CVD events among African American adults. Objective: Determine whether the associations between SES indicators and CVD events are moderated by John Henryism (JH). Hypothesis: The inverse association between SES and CVD events will be more pronounced among those who score “high” on the 12-item John Henryism Scale for Active Coping (JHAC) versus those who do not. Methods: Jackson Heart Study participants with complete data and no CVD at baseline (2000-2004) were utilized (n=1828, mean age: 52.15 years). SES indicators included insurance status, income, years of education, and years of maternal and paternal education. JH was defined using a tertile distribution of the JHAC scores (0-36): low JHS (&lt;28), moderate JHS (29-32), and high JH (&gt;32). CVD events from baseline to 2016 included coronary heart disease (CHD), stroke, and heart failure (HF). Cox proportional hazards regressions determined the hazard ratio (HR, 95% CI) of CVD events by SES variables. Moderation by JH was determined by including interaction terms in the models and stratification of results. Models were adjusted for age, sex, smoking, physical activity, nutrition, obesity, hypertension, and diabetes. Results: There were 94, 61, and 100 CHD, stroke, and HF events, respectively that occurred by 2016 (mean follow-up: 13 years for CHD and Stroke and 10 years for HF). Each SES indicator was inversely associated with CVD events, except for income (only associated with HF) and insurance (not associated with CHD). There was a significant interaction between income and JH in the hazard of HF (p=0.04). Specifically, low-income participants with high JH had a greater hazard of HF after full adjustment (HR 1.85, 95% CI 1.21, 2.83). Low-income participants with low JH also had a greater hazard of HF (HR 1.43, 95% CI 1.06, 1.93) after adjustment for age and sex, but the association attenuated after adding health behaviors and risk factors. Conclusion: Engaging in high-effort coping and having low SES is detrimental to cardiovascular health. The association between income and HF was moderated by JH, thus interventionists should consider interactions between SES and high-effort coping when exploring ways to prevent CVD.